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Recreation & Personal Development Funding Application Form
(Special Purpose Fund)
Personal Details
Members Name:
*
First name
Middle name
Last name
Members Address:
Address line 1
Address line 2
City/Suburb
State/Territory
Postcode
Home phone:
(nnnn nnnn)
enter phone number as nnnn nnnn (no area code required)
Mobile:
(nnnn nnn nnn)
enter mobile number as nnnn nnn nnn
Email address
My Goal for this activity is to:
*
Member Signature:
please sign here unless you are selecting to verbally sign (below)
Clear
Verbally Signed:
please tick this box if you are verbally signing form
Member Signed Date:
*
please select date you are signing form
Training Details
Supplier/Provider Business Name
Supplier/Provider Phone
Upload Supplier/Provider Quote
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SPF Subsidy $
Enter the amount you would like to apply for *up to $250 per term
**Please Note: In the case of gym memberships where costing is deemed of greater value, member may discuss option for 6-month membership
End of Term Outcome:
What have you gained through undertaking this activity?
Did you achieve your initial goal/plan?
Please check the highlighted fields
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